Thursday, November 22, 2018

House Speaker José Oliva says Florida health care 'behind the curve'

Have no doubt: new House Speaker José Oliva wants to expand access to health care by expanding the scope of practice for Florida nurses.

He also wants less government regulation in Florida’s health-care delivery system and more free-market principles.

Oliva, though, denies that reconfiguring the state’s health-care delivery system will be his personal priority as House speaker over the next two years. Instead, he maintains the issue transcends one man’s goals.

“This isn’t a priority that I chose to make my priority,” Oliva told reporters, following his designation as House speaker this week. “This is the state’s priority. It’s taking up our entire budget.”

There already are indications that Oliva’s proposals may be in for some trouble in the Florida Senate, where President Bill Galvano, a Republican from Bradenton, is more reserved about the need for changes.

For instance, Oliva told reporters that he wants to allow nurses “to practice to the extent of their training.”

“I think we’re way behind the curve as a state,” he said.

But during a recent media availability, Galvano said he wants to “make sure we are listening to our doctors in terms of what they see in the system.”

If the state hasn’t maximized the use of its available workforce, Florida’s doctors and dentists may have played a part.

Organized medical associations have killed efforts to expand the scope of practice for non-physicians, successfully arguing that only highly trained medical professionals are capable of safely providing the care that’s needed.

For political insiders, it’s no surprise that Oliva is pursuing a health-care agenda.

Prior to becoming speaker, Oliva twice chaired select health-care committees, including the Select Committee on Health Care Workforce Innovation in 2013 and the Select Committee on Affordable Healthcare Access two years later.

Oliva has made his opinions on Florida’s health-care system clear, including his support of the state’s certificate of need program, which is a licensure program of sorts. Currently, certificates of need are required for new hospitals and nursing homes, as well as for tertiary services, such as transplant programs and high risk nurseries.

Nationally, 14 states have certificate of need requirements for any type of health-care facility or service. Eight additional states have certificate of need laws for construction of new facilities but do not have certificate of need requirements relating specifically to the addition of hospital beds.

Mainstream or not, Galvano is more cautious about eliminating certificate of need requirements than his House counterpart.

“I’m open to revisiting it, but I want to make sure we move very cautiously in the health-care realm, because it is not like selling cellphones,” he said.

This won’t be the first time the chamber will be at odds on health care.

The Florida Senate in 2015 pushed for a Medicaid expansion, allowable under the federal health-care law. But members of the House were steadfast in their opposition. Opposed to expanding Medicaid for low-income childless adults, House leaders offered a slate of bills they said would improve access to health care by lowering costs. Most of those bills failed and will be revisited by the House this year.

In addition to elimination of the CON program, the House pushed for bills that would allow ambulatory surgical centers to treat patients overnight and allow the establishment of extended-care centers where patients could rehabilitate for up to three days.

The measures were adamantly opposed by Florida hospitals, which successfully argued that the proposals would shift healthier patients away from their facilities and leave them with the sickest patients. They also noted that hospitals are required to take Medicaid patients but there are no similar mandates on ambulatory surgical centers.

Oliva railed against the hospitals, referring to them as the “hospital-industrial complex” during floor debates and even on social media. The term echoed President Dwight Eisenhower’s warning about the growing power of the “military-industrial complex” on the eve of the Vietnam War.

The cost of health care is the reason Oliva says he is pushing a health-care agenda. The Republican from Miami Lakes says that 48 percent of the state’s spending this year will be on health care. A state fiscal analysis, however, shows that Oliva may be inflating his figures.

According to state economists, 41.7 percent of the state budget is directed to “human services,” which includes spending for Medicaid and for a variety of other programs outside of health care, such as protection for the elderly and environmental programs located within the state health department.

And the percentage of the budget spent on human services includes both state and federal dollars.

Regardless of the math, Galvano, like Oliva, said he wants to review the delivery system and “see if we can make better opportunity from a cost perspective.”